Provider Demographics
NPI:1487998373
Name:TESSEL, PATRICIA A (MFT INTERN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:TESSEL
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 PENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6901
Mailing Address - Country:US
Mailing Address - Phone:818-613-4618
Mailing Address - Fax:
Practice Address - Street 1:14653 GAULT ST
Practice Address - Street 2:VALLEY TRAUMA CENTER
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3042
Practice Address - Country:US
Practice Address - Phone:818-626-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 71643106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist